Risk factors associated with tongue lesions: a propensity score-matched case-control study.

BACKGROUND: to analyse the potential risk factors of tongue lesions, comparing the results with a control group. MATERIAL AND METHODS: An observational, case-control study was designed. The study included a case group comprising 336 patients with tongue lesions and 336 sex and age-matched controls. We recorded tobacco/alcohol habits, presence of dentures, allergies, medical conditions, and medications. Statistical analysis was performed via logistic regression models to estimate the odds ratio (OR) adjusted for gender, age, tobacco, and alcohol using propensity score-matching analysis (PSM). RESULTS: According to the final PSM model, patients with tongue lesions were more likely to suffer from allergies (OR 2.13; 1.27-3.66) or medical conditions (OR 2.14; 1.19-3.85), and more likely to take medication (OR 1.99; 1.11-3.57). Elderly individuals were more prone to hairy tongue (OR 3.82; 1.53-10.47). Smoking was associated with coated tongue (OR 2.05; 1.12-3.63), hairy tongue (OR 3.77; 1.52-9.22) and median rhomboid glossitis (OR 40.49; 5.84-860.43). Allergic individuals were more likely to exhibit sublingual varices (OR 1.73; 1.02-2.88). Medical conditions increased the chances of having coated tongue (OR 2.44; 1.36-4.64) or crenated tongue (OR 2.70; 1.42-5.30). Arterial hypertension was associated with median rhomboid glossitis (OR 5.85; 1.08-34.18). Individuals on medication showed a higher risk of fissured tongue (OR 1.87; 1.20-2.94) and varices (OR 2.42; 1.58-3.80). Agents acting on the alimentary tract and metabolism increased the probability of fissured tongue (OR 2.31; 1.42-3.79). CONCLUSIONS: As far as we are aware, this is the first study on lingual pathology to include a PSM analysis. The results suggest that a history of allergies, the presence of medical conditions, and the use of medication are associated with increased probability of tongue lesions. The analysis of diseases and medications by subgroups requires studies matched by habits with larger sample sizes, in order to corroborate our observations.

Oral cancer awareness in North-Western Spain: a population-based study.

BACKGROUND: An early diagnosis depends greatly on patient awareness. Thus, the aim of this study was to investigate general awareness of oral cancer and knowledge about its risk factors, signs and symptoms. MATERIAL AND METHODS: Cross-sectional population-based survey of randomly selected respondents conducted from March 1, 2015 to 30 June 2016. RESULTS: A total of 5,727 people entered the survey (response rate: 53%). When asked what cancers participants had heard about, 20.3% mentioned oral cancer. Regarding risk factors, tobacco was mentioned by 55.3% of the sample (n=3,169), followed by alcohol (12.5%; n=708), poor oral hygiene (10.8%; n=618), diet (6.5%; n=377), and genetics (4.5%; n=248). CONCLUSIONS: General population has low awareness of oral cancer with poor knowledge of risk factors and main alarm signs. In addition, individuals in the risk group scored lower values in the main variables analysed; even those highly educated showed insufficient awareness and knowledge of oral cancer. In these circumstances, there is clear need for educational interventions tailored to the target audience and aimed at increasing knowledge and awareness of oral cancer to promote primary prevention of oral cancer and minimising the time interval of patients with symptomatic oral cancer in their path to treatment.

People would rather see a physician than a dentist when experiencing a long-standing oral ulceration. A population-based study in Spain.

BACKGROUND: Primary care physicians have been reported to be the first choice for patients with oral ulcerations. This study investigates the health-seeking behaviour of lay public in Galicia (North-western Spain) if experiencing a long-standing oral ulceration. MATERIAL AND METHODS: Cross-sectional population-based survey of randomly selected respondents conducted from March 1, 2015 to 30 June 2016. RESULTS: A total of 5,727 pedestrians entered the study (response rate: 53%), mostly in the 45-64 age group (30.2%; n=1,728), 47.7% of them (n=2,729) were males. Most participants (42.1%; n=2,411) reported to visit their dentist once a year and had secondary or compulsory education as their highest educational achievement (28.18%, n=1,614; 28%, n=1,600 respectively). When questioned what they would do if they had a wound/ulceration lasting longer than 3 weeks, most participants answered they would go to see their primary care physician (62.8%; n=3,597) and less than one quarter of the sample (23.8%; n=1,371) would seek consultation with their dentist. CONCLUSIONS: General Galician population would seek professional consultation about a long-standing oral ulceration, relying mostly on primary care physicians. Those neglecting these lesions are elderly, less-schooled people and unaware of oral cancer.

Therapeutic approaches for actinic cheilitis: therapeutic efficacy and malignant transformation after treatment.

Actinic cheilitis (AC) is a sun-induced premalignant lesion. AC is a clinical term housing a wide pathological spectrum ranging from hyperkeratosis to invasive squamous cell carcinoma. The aim of this systematic review was to examine the therapeutic efficacy of different approaches in clinical, histological, and cosmetic terms, and the malignization rate after treatment. A systematic search was undertaken in October 2016 and updated in April 2019 at MEDLINE (from 1966), Embase (from 1980), and Proceedings Web of Science (Conference Proceedings Citation Index-Science (CPCI-S) from 1990) databases. The search strategy was (("actinic" or "solar") AND ("cheilitis")) using both medical subject headings (MeSH) and freetext. A total of 392 potentially eligible reports were identified. After the selection procedure, 20 articles were included. It was concluded that surgical treatment is the first line of treatment for AC and has proved useful for the clinical and pathological control of the disorder. However, there was no evidence of effective treatment in preventing malignant transformations. Non-surgical procedures showed less consistent results, although drug therapy may improve the results obtained by other therapeutic approaches.

Oral mucosal peeling related to dentifrices and mouthwashes: A systematic review.

BACKGROUND: The aim of this systematic review was to summarise the clinical information available about oral mucosal peeling (OMP) and to explore its aetiopathogenic association with dentifrices and mouthwashes. MATERIAL AND METHODS: PICOS outline. Population, subjects diagnosed clinically and/or pathologically. Intervention, exposition to oral hygiene products. Comparisons, patients using products at different concentrations. Outcomes, clinicopathological outcomes (primary) and oral epithelial desquamation (secondary) after use. Study design, any. Exclusion criteria, reports on secondary or unpublished data, in vitro studies. Data were independently extracted by two reviewers. RESULTS: Fifteen reports were selected from 410 identified. Descriptive studies mainly showed low bias risk, experimental studies mostly an "unclear risk". Dentifrices or mouthwashes were linked to OMP, with an unknown origin in 5 subjects. Sodium lauryl-sulphate (SLS) was behind this disorder in 21 subjects, tartar-control dentifrices in 2, and flavouring agents in 1 case. Desquamation extension was linked to SLS concentration. Most cases were painless, leaving normal mucosa after desquamation. Tartar-control dentifrices caused ulcerations more frequently. CONCLUSIONS: OMP management should consider differential diagnosis with oral desquamative lesions, particularly desquamative gingivitis, with a guided clinical interview together with pathological confirmation while discouraging the use of the product responsible for OMP.

Oral hygiene instructions and professional control as part of the treatment of desquamative gingivitis. Systematic review.

BACKGROUND: The aim of this present article was to evaluate the scientific evidence on the efficacy of daily hygiene and professional prophylaxis for treatment of desquamative gingivitis. MATERIAL AND METHODS: The present systematic review was conducted following the PRISMA protocol. Searches were carried out in Pubmed, Embase, Web of Science and Cochrane Library up to July 2018, randomized clinical trials and cohort studies on desquamative gingivitis (DG), and oral diseases joined to DG. RESULTS: After screening, we found that nine publications met the eligibility criteria eight cohort studies and one randomized control trial. The diagnosis of the diseases corresponded to oral lichen planus (n=185), mucous membrane pemphigoid (n=13); plasma cell gingivitits (n=15) and pemphigus vulgar (n=11). The follow-up was between a week and a year after instructing patients. Dental daily hygiene and professional prophylaxis, at least with supragingival scaling and polishing have significantly improved the extension of the lesion and reduced the activity of DG, and gingival bleeding in all patients. Furthermore, these techniques have also reduced pain and gingival plaque. CONCLUSIONS: In conclusion the studies presented support the efficacy of maintaining personal and professional oral hygiene in patients with GD, reducing the clinical signs of the disease, regardless of its pathogenesis.

Geographic tongue: Predisposing factors, diagnosis and treatment. A systematic review. / Lengua geográfica: factores predisponentes, diagnóstico y tratamiento. Revisión sistemática.

INTRODUCTION: Geographic tongue (GT) is a lesion of unknown origin associated with systemic diseases and therefore involves multidisciplinary care. METHODS: We performed a literature search of the PubMed, EMBASE, Web of Science and Cochrane databases. The selection criteria were consistent with the Preferred Reporting Items for Systematic Reviews protocol. We considered as inclusion criteria journal articles designed on cases of cohorts, cross-sectional studies, cases and controls and randomised clinical trials in the pathogenic, clinical and therapeutic context. RESULTS: A total of 33 articles met these criteria. We analysed 4998 patients with GT, with an age range of 0 to 85 years, and the burning sensation symptom was present in 9.2-47% of these patients. The GT diagnosis was clinical in 98.81% of the cases, and GT displayed an association with psoriasis, allergies and anxiety. Candida infection was present in 7.6% (24/315) of the cases, and the presence of caries was statistically significant. The only analysed clinical trial proposed treatment through the topical application of 0.1% triamcinolone acetonide combined or not with 0.05% retinoic acid. CONCLUSIONS: The diagnosis of GT is mainly clinical. GT is an asymptomatic disorder that usually requires no treatment. Understanding GT is necessary due to the comorbid intraoral and extraoral diseases that accompany the condition.

The development of proliferative verrucous leukoplakia in oral lichen planus. A preliminary study.

BACKGROUND: Was to describe 14 cases of a proliferative verrucous leukoplakia as a clinical evolution of oral lichen planus. MATERIAL AND METHODS: The clinical and histopathological characteristics of 14 cases of OLP that progress towards a plaque-like and verrucous form were indicated, with monitoring over a period of six to 24.3 years. RESULTS: The female/male ratio was 11/3, (78.6 and 21.4%). The mean age when the first biopsy was undertaken was 56.4 years old. None of the patients smoked during the study. As bilateral reticular was clinically diagnostic criterion, the second most frequent clinical form was the plaque form (n=10; 71.4%), followed by the atrophic (n=6; 42.8%), and erosive forms (n=4; 28.5%). Clinically it spread towards attached gingival mucosa and the hard palate. In the histopathologic study, there were a predominance of hyperkeratosis and verrucous epithelial hyperplasia. Three of the cases progressed to a squamous cell carcinoma, and one patient developed two verrucous carcinoma. CONCLUSIONS: Further research is needed to demonstrate if proliferative multifocal oral lichen planus and proliferative multifocal oral leukoplakia are the same disorder but have different behaviour of malignancy for reasons of origin.

Expression of heat shock protein (HSP70) in oral lichen planus and non-dysplastic oral leucoplakia.

The purpose of this study was to investigate the expression of heat shock protein (HSP70) in oral non-dysplastic leucoplakia and in relation to the clinical and pathological features of oral lichen planus. The expression of HSP70 was assessed in the epithelial compartment of normal mucosa (n = 5), oral lichen planus (n = 28) and benign leucoplakia (n = 11) using an immunohistochemical method. The immunostaining intensity distribution (IID) index was used to quantify the positivity of the staining. There was no association between HSP70 overexpression and clinical presentation of oral lichen planus. Oral lichen planus patients showed no statistically significant differences in the depth of the inflammatory infiltrate when expression of HSP70 was considered (X(i)- X(j) = 42.30; 95% confidence interval (95% CI) = -120.87-205.48). No statistically significant differences were identified in terms of HSP70 expression between oral lichen planus and normal buccal mucosal specimens (X(i)- X(j) = 4.07; 95% CI = -0.53-8.67). The IID index score for HSP70 expression in leucoplakia specimens was significantly higher than the one of the oral lichen planus group (X(i) - X(j)= 5.11; 95% CI = 1.73-8.48). It is concluded that there are no statistically significant differences in HSP70 expression between oral lichen planus and normal buccal mucosal specimens, suggesting that HSP70 does not play an obvious part in the pathogenesis of oral lichen planus. The expression of HSP70 was significantly higher in oral leucoplakia than in oral lichen planus, possibly because of differences in cellular activity or cell proliferation.

Concordance between undergraduate dental students and their lecturers in their attitudes towards difficult patients.

The 'difficult' patient syndrome is caused by an imbalance in the dentist-patient relationship which may be influenced by human, cultural and psychosocial factors. The aim of this study was to compare the concordance between undergraduate dental students and lecturers in the degree of difficulty assigned to vignettes describing 'difficult' patients and to describe the extent to which ratings are influenced by gender, place of study and experience of specific 'difficult' patients. A questionnaire with 21 patient-stereotypes identified as difficult from the specialized literature was prepared. Both students and lecturers had to determine the degree of difficulty of each stereotype on a Likert-like scale. The students selected were in the final 2 years before graduation in Santiago de Compostela (Spain) and Porto (Portugal) Dental Schools. Lecturers were selected by simple random sampling method. Both lecturers and undergraduate students found more difficulty in those patients classified as aggressive, manipulative help-rejecters or patients with invasive companions. On the other hand, drug abusers and HIV-positive patients were ranked as presenting low levels of difficulty. Our results seem to point to the need of improving undergraduate teaching and learning of specific procedures for the management of aggressive or stubborn patients and those with invasive companions.

Prevalence of oral lesions in the 6-year-old pediatric population of Oviedo (Spain).

OBJECTIVE: The present study investigates the prevalence of oral diseases in children in the city of Oviedo (Spain). METHODS: A representative sample was selected from among the 6-year-old children in Oviedo (n= 786), involving a protocol developed for pediatric oral diseases. RESULTS: A total of 344 lesions were detected in 243 children. The most common disorder was saburral tongue (16,02%), followed by traumatisms (12.17%) and geographic tongue (4.48%). The prevalence of aphthous stomatitis was 2.24% and herpes labialis was 1,6%. Ankyloglossia was observed in 2.08% of cases, and a hypertrophic lip frenulum in 1.28%. CONCLUSIONS: In this study shows the prevalence of the lesions of the oral mucosa in the Spanish population of 6 year-old. Of the results of the present study comes off that the objectives sanitary oral publics and deprived in this field they should go focused toward: 1) the eradication of illnesses of local cause (language saburral, traumatic ulcerations, etc.) for their high prevalencia; and, 2) the precocious diagnosis of anomalies of the development (anquiloglosias and labial frenum) for their relationship with dysfunctions of the phonation and future malocclusions.

Prevalence of diabetes mellitus amongst oral lichen planus patients. Clinical and pathological characteristics.

OBJECTIVES: The aim of this study has been to define the prevalence of DM (considered according to the ADA-97 criteria) in OLP patients and also to investigate the existence of clinical and pathological differences between OLP patients with or without DM. STUDY DESIGN: Sixty-two patients suffering from OLP according to clinical and pathological criteria were selected to enter the study and classified after the DM diagnosis guidelines suggested by The American Diabetes Association (ADA-1997). The variables considered for each patient were: age, sex, clinical presentation, extension of the lesions, location of the lesions, number of locations, Candida albicans colonization, and density of subepithelial inflammatory infiltrate. RESULTS: Up to 27.4% of OLP cases were associated to type 2 DM (DM2) and 17.7% were related to an impaired fasting glucose (IFG). The mean age of the DM2-associated OLP group was significantly higher than the non-diabetic group's. No significant differences could be observed in terms of clinical and pathological features between diabetic and non-diabetic OLP patients. CONCLUSION: The high prevalence of hydrocarbonate metabolism disorders observed in OLP patients justify the use of FPG for screening of DM2 in these patients.